Respiratory health and the Syrian conflict: a scoping literature review.

Conflict adversely affects respiratory health in both direct and indirect ways among populations whose health is already compromised through the compounding effects of conflict. Our aim is to review academic and grey literature relevant to respiratory health in the Syrian conflict (now more than a decade in duration) to explore its impacts on populations across Syria. We performed a scoping literature review of academic and grey literature on respiratory health in Syria between March 2011 (taken as the start of the conflict for practicality) and December 2023. Of 11,472 papers screened, 34 met the inclusion criteria, of which 29 were peer reviewed. Key themes identified included the impact of conflict on asthma diagnosis and management; the burden of respiratory tract infections (RTIs) and COVID-19; the impact of chemical weapon use and the impact of destruction and interruptions to the health system(s) across Syria on respiratory health. This review highlights the need for more in-depth exploration of the impact of conflict on respiratory health in Syria with focus on social determinants, for example, shelter, public health interventions, smoking cessation, and supporting early diagnosis and treatment of respiratory conditions to counter the effects that conflict has had on respiratory health.

Antioxidant activity of aerial parts of Tribulus alatus in rats.

The antioxidant activity of alcoholic extract of Tribulus alatus was investigated by determination of blood glutathione, serum ascorbic acid and serum superoxide dismutase in rats. All groups treated with aerial parts without fruit, fruits and total herb showed a significant increase in all measured parameters (P<0.05). Upon fractionation of the alcoholic extracts using solvents with different polarities, all fractions revealed a significant increase in serum superoxide dismutase (P<0.05). On the other hand chloroformic fraction of aerial parts without fruit extract and ethylacetate fraction of fruits extract exhibited a significant increase in blood glutathione level. All fractions of fruits extract, chloroformic and ethylacetate fractions of aerial parts without fruit extract significantly increase the serum ascorbic acid concentration (P<0.05).

Specific IgG avidity in acute and chronic human fascioliasis.

The detection of IgG avidity in sera is potentially useful in the diagnosis of acute and chronic infection. We studied IgG avidity in 31 patients with fascioliasis, with the aim of evaluating the clinical application of this test to confirm the diagnosis of incubating cases and to distinguish between acute and chronic cases. Of the 31 cases, 13 were incubating and had a mean avidity index of 57.28 +/- 5.79%. The 18 chronic cases had an avidity index of 68.80 +/- 8.92%. The difference was highly significant. We conclude that IgG avidity is a reliable means of identifying the stage of fascioliasis and suggest a cut-off point of 59.90% to distinguish between acute and chronic infection.

Hepatic fibrosis due to fascioliasis and/or schistosomiasis in Abis 1 village, Egypt.

An epidemiological study of fascioliasis and/or schistosomiasis was conducted in Abis 1 village. Stool specimens were collected from 2492 individuals and examined. Fascioliasis, alone or combined with schistosomiasis, was more prevalent among children aged between 5 years and 15 years than in adults. Serum procollagen III peptide (PIIIP) levels were determined as an indicator of active fibrosis, and liver histopathology and ultrasonography used as indicators of established fibrosis. PIIIP levels were significantly higher in children than in adults, and in mixed infections than in fascioliasis alone. In adults, fibrosis around granulomata detected by histopathology and grade 3 periportal fibrosis detected by sonography were encountered more frequently in dual than in single infections.

Epidemiological study of heterophyiasis among humans in an area of Egypt.

We aimed to determine the prevalence and intensity of infection of heterophyiasis among inhabitants of El-Meaddeya, Egypt. A cross-sectional stool examination survey was performed on 430 randomly chosen households, comprising 2219 individuals. The overall prevalence of parasitic infection was 84.7%. Ascariosis was the most common (67.6%), followed by trichuriosis (49.7%) and heterophyiasis (33.8%). The prevalence and intensity of infection of heterophyiasis were most common in people 15-45 years, and greater in females than males. The highest intensity of infection was detected among fishermen. Intrafamilial aggregation of cases of heterophyiasis was identified.

Performance of IgG avidity in an area endemic for schistosomiasis in Egypt.

We assessed the performance of IgG avidity in the diagnosis of acute, chronic and recent (reinfection) on top of chronic schistosomal infections in patients treated with praziquantel. Immunoglobulin levels were studied in 111 patients with Schistosoma mansoni infection and 28 partially cured patients (not responding to the first dose of praziquantel treatment and almost cured after a second one). Before treatment all patients with schistosomiasis had elevated IgG levels, 75% of them also had increased IgM levels. Avidity index was high among all age groups. The increased IgM/IgG ratio and avidity index among children with schistosomiasis before treatment support the idea of reinfection. Treatment had no significant effect on the studied parameters. We conclude that unlike IgM and IgG antibody levels, IgG avidity test cannot be used to distinguish between recent and chronic infections.

Triclabendazole in the treatment of human fascioliasis: a community-based study.

The efficacy of triclabendazole in the treatment of chronic Fasciola infection was assessed. A total of 134 asymptomatic cases of established Fasciola infection were treated: 68 individuals received a single dose of 10 mg/kg and 66 individuals received 2 doses of 10 mg/kg on 2 consecutive days. Cure was assessed 5 weeks after treatment and 79.4% of the first group and 93.9% of the second group were cured. The drug was well tolerated; no serious side-effects were noted. One patient developed biochemical cholestasis the third day after treatment, but her enzyme profiles returned to normal after 2 months. We conclude triclabendazole is a safe and potent fasciolicidic drug.

Differential adhesion molecule expression during murine embryonic stem cell commitment to the hematopoietic and endothelial lineages.

Mouse embryonic stem cells (ESC) make cell fate decisions based on intrinsic and extrinsic factors. The decision of ESC to differentiate to multiple lineages in vitro occurs during the formation of embryoid bodies (EB) and is influenced by cell-environment interactions. However, molecular mechanisms underlying cell-environmental modulation of ESC fate decisions are incompletely understood. Since adhesion molecules (AM) influence proliferation and differentiation in developing and adult tissues, we hypothesized that specific AM interactions influence ESC commitment toward hematopoietic and endothelial lineages. Expression of AM in the adherens, tight and gap junction pathways in ESC subpopulations were quantified. E-cadherin (E-cad), Claudin-4 (Cldn4), Connexin-43 (Cx43), Zona Occludens-1 (ZO-1) and Zona Occludens-2 (ZO-2) transcript levels were differentially expressed during early stages of hematopoietic/endothelial commitment. Stable ESC lines were generated with reduced expression of E-cad, Cldn4, Cx43, ZO-1 and ZO-2 using shRNA technology. Functional and phenotypic consequences of modulating AM expression were assessed using hematopoietic colony forming assays, endothelial sprouting assays and surface protein expression. A decrease in E-cad, Cldn4, Cx43 and ZO-1 expression was associated with less commitment to the hematopoietic lineage and increased endothelial differentiation as evidenced by functional and phenotypic analysis. A reduction in ZO-2 expression did not influence endothelial differentiation, but decreased hematopoietic commitment two-fold. These data indicate that a subset of AM influence ESC decisions to commit to endothelial and hematopoietic lineages. Furthermore, differentially expressed AM may provide novel markers to delineate early stages of ESC commitment to hematopoietic/endothelial lineages.

Pharmacokinetics of theophylline after administration of suppositories formulation.

Asthma is a public health problem for developed countries. It attacks all age groups but often starts in childhood. Theophylline ethanoate of piperazine in a suppository form is one of the treatments of asthmatic children. The pharmacokinetics of theophylline were evaluated in 24 healthy male subjects after administration of theophylline ethanoate of piperazine suppositories (PR) (Minophylline 500 mg. Alexandria Co.) and single injection intravenous (IV) of theophylline ethanoate of piperazine (Minophylline ampoules 500 mg Alexandria Co.). The theophylline serum levels were determined by an ELISA method. Peak theophylline plasma concentration, Cmax, (mean +/- S.D) was 21.5 +/- 2.10 microg/mL & 14 +/- 0.90 microg/mL; AUC(0-t), values were 80.9 and 67. 4 microg x ml x hr for the reference IV preparation and suppositories, respectively. The median peak time, Tmax, was 0.5 hr for theophylline rectal administration. The above mentioned results demonstrate the possibilities of using theophylline (Minophylline Suppositories--500 mg Alexandria Co.) in asthmatic children in rural and desert areas away from health care personnel.

The effect of Ambrosia maritima (Damsissa) on the viability of Lymnaea cailliaudi; an experimental study.

The present work aimed at studying the effect of Ambrosia maritima (Damsissa) on the viability of Lymnaea snails. Lymnaea snails used in these trials were acclimatized to laboratory conditions before use in the toxicity test. The snails were exposed to various concentrations (100-3000 mg/l) of dry powdered Damsissa, Ambrosia maritima was lethal to Lymnaea snails at concentration of 3000 mg/L after one day and at 100 mg/l after 14 days.

A study of the ultrastructure of the intestines of mice experimentally infected with S. mansoni and treated with praziquantel.

The present experimental work studied the ultrastructural changes occurring in the intestines of mice infected with S. mansoni and treated with praziquantel. Mild degenerative changes of the intestinal cells together with degranulation of the APUD cells were observed. The enterochromaffin cells in the intestines secrete serotonin which is a vaso constrictor and a strong stimulator of the smooth muscles. A possible explanation of the side effects of praziquantel is thus offered.

Uncommon complications of human fascioliasis in Alexandria.

Fascioliasis is becoming more frequently discovered among citizens of Alexandria. The main presenting clinical manifestations including hepatic pain, colics, fever, anorexia, discomfort with meals and hepatomegaly. We select here 4 cases with unusual presentation from patient's record of the last year: one case developed liver abscess due to F. hepatica infection. Two cases were encountered during cholecystectomy in patients suffering from cholecystitis with cholelithiasis; in one of them the gall bladder had ruptured and the patient developed an abscess in the liver related to the gall bladder bed. In both cases F. hepatica worms were found in the bile duct. The fourth case presented with acalcular cholecystitis with empyema of the gall bladder.

Human fascioliasis: T cell subsets in liver before and after bithionol treatment.

Liver biopsies from 5 patients with established fascioliasis, before and after bithionol treatment were studied by immunoalkaline phosphatase technique for relative distribution of T cells and their subpopulations. T cell and its subsets are defined for OKT3+ (pan T), OKT4+ (helper/inducer) and OKT8+ (suppressor/cytotoxic) cells by using mouse monoclonal antibodies. Before bithionol treatment, lymphocytic infiltration in all hepatic lesions were predominantly of OKT3+ (pan T) lymphocytes. The distribution of OKT8+ cells was moderate to severe in comparison to the few OKT4+ cells presentation. After bithionol a noticeable regression of the OKT3 lymphocytic in all liver sections. The majority of the lymphocytic infiltration was of the OKT8+ cells, in comparison to the absence of the OKT4+ ones. This may indicate that suppressor/cytotoxic lymphocytes may have a role in the immune regulation of the disease and the mode of action of bithionol is by the accentuation of this immunoregulatory effect.

Human fascioliasis: ultrastructural study on the liver before and after bithionol treatment.

The pathology of human fascioliasis was studied before and after bithionol treatment using light and transmission electron microscopy. Fine needle biopsies were taken from five patients, with established fascioliasis, before and after drug administration. By light microscope the pathology of human fascioliasis was similar to that reported in experimental fascioliasis. The ultrastructural picture revealed bile ductular hyperplasia, fibrosis of portal tracts, widening of the interhepatic spaces by many microvilli and dilated Disse space with collagen fibres. Bile ductular hyperplasia may be the initial factor to fibrinogenesis, which subsequently enhance the development of the microvilli on the surface of the hepatocytes. Both light and electron microscopic studies revealed regression of the picture of fascioliasis to normal after bithionol treatment with no sign of toxicity on the liver.

Direct enantioselective separation of clenbuterol by chiral HPLC in biological fluids.

An isocratic and simple high-performance liquid chromatographic method was developed for the direct resolution of the clenbuterol enantiomers. The method involved the use of a urea type chiral stationary phase (CSP) made of (S)-indoline-2-carboxylic acid and (R)-1-(alpha-napthyl) ethylamine known as the Chirex 3022 column. The stereochemical separation factor (alpha) obtained was 1.27 and the stereochemical resolution factor (Rs) was 4.2 when using a mobile phase composed of hexane:1,2-dichloroethane:ethanol/trifluoroacetic acid (80:10:10 by vol) at 23 degrees C. The (+)-R enantiomer eluted first, with a capacity factor (k'2) of 2.67 followed by (-)-S enantiomer with a capacity factor (k'1) of 3.38. As standard linear calibration curve was constructed over the range of 10 nmol/mL to 250 nmol/mL with a correlation coefficient of 0.999. The method is specific and sensitive with a lower limit of quantitation of 0.1 nmol. Data demonstrating recovery and precision of the assay are presented and the method has been used to monitor and identify quantitatively the profile of the enantiomers of clenbuterol in biological fluids.

Experimental murine schistosomiasis: reduced hepatic morbidity after pre- and/or post-infection treatment with ibuprofen or diclofenac sodium.

Arachidonic-acid metabolites appear to participate in skin penetration by and transformation of schistosome cercariae and in the pathogenesis of schistosomiasis. With this in mind, mice were treated with one of two cyclooxygenase inhibitors before and/or after infection with Schistosoma mansoni. The effects of the treatment on liver morbidity and the parasitic infection were then evaluated, using infected, untreated and uninfected, treated mice as controls. Treatment with ibuprofen (20 mg/kg.day) or diclofenac sodium (2.5 mg/kg.day) for 7 days before infection led to significantly lower liver weights, worm loads and hepatic hydroxyproline contents than in the untreated mice. If treatment with either drug was continued after infection, for 28 days, there was an additional significant decrease in hepatic gamma-glutamyl transpeptidase activity. All these parameters except liver weight were similarly affected when treatment with either drug was begun on the day of infection and continued for 28 days. There was no significant change in liver weight or worm load when treatment was delayed until day 28 post-infection but faecal egg counts were reduced in the treated groups. In additional experiments, using a smaller dose of diclofenac sodium (1.25 mg/kg.day), all the measured parameters of infection were significantly decreased when the treatment was initiated 7 days before infection and continued until day 28 post-infection. The results indicate that the treatment of S. mansoni-infected mice with ibuprofen or diclofenac sodium was effective in reducing the severity of infection and in attenuating hepatic fibrosis, particularly when the treatment was started early in relation to the time of infection.

Detection of circulating E/S antigens in the sera of patients with fascioliasis by IELISA: a tool of serodiagnosis and assessment of cure.

An IELISA was developed to evaluate the performance of Fasciola E/S antigens in diagnosis and cure assessment of human Fasciola infection. Twenty patients with acute (prepatent) fascioliasis and another 20 with patent infection were enrolled in the study. Patients were treated with TCZ and followed at 1, 3 and 6 months after therapy. At inspection, the sensitivity of the test to diagnose prepatent cases was 100% compared to 70% for patent infections. There was a gradual decrease of antigenaemia over the follow-up period in acute cases. In chronic cases antigen disappeared from 13 cases (65%) at 1 month; this proportion did not change at 3 or 6 months.

Circulating antibodies and antigens correlate with egg counts in human fascioliasis.

We explored the relationships between specific IgG antibody levels and circulating E/S antigen to intensity of Fasciola infection in the human host. Twenty patients with patent infection and six healthy individuals were enrolled in the study. Intensity of infection was determined by repeated egg counts in stools, while IgG antibodies against adult Fasciola gigantica somatic FI, FII and against E/S antigens were measured as ELISA O.D. readings. The level of circulating E/S antigens was determined by IELISA. Positivity as well as levels of antibodies and antigen correlated with infection intensity. These findings may disclose in the future a relation between morbidity in the acute phase and worm load.

Diagnostic significance of Schistosoma mansoni proteins Sm31 and Sm32 in human schistosomiasis in an endemic area in Egypt.

We performed a series of ELISAs to evaluate the diagnostic significance of two Schistosoma mansoni proteins, Sm31 (cysteine proteinase, cathepsin B) and Sm32 (asparaginyl endopeptidase). Our study populations were chosen from two villages in an endemic area close to Alexandria. Using fusion proteins MS2-Sm31 and MS2-Sm32 as antigens, 70% and 78.9%, respectively, of patient sera from 134 parasitologically confirmed cases reacted positively. The percentage of seropositivity increased to 84.5% when parasite-derived proteins Sm31 and Sm32 were used. The serum levels of antibodies to these two proteins in recombinant or native forms do not correlate with intensity of infection and hence are detected even when egg counts are low, which makes proteins Sm31 and Sm32 useful antigens in the identification of S. mansoni infected cases, particularly in endemic areas in Egypt.